DKD, or diabetic nephropathy: pathophysiology, symptoms, risk factors, diagnosis and management. For patient education. This video is available for instant download licensing here:
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Diabetic kidney disease, or diabetic nephropathy, is kidney disease caused by diabetes. It’s a very common diabetic complication, affecting about one third of people with diabetes type 1, and half of those with diabetes type 2. Diabetic kidney disease is responsible for most of the excess mortality associated with diabetes.
Because the kidneys remove metabolic wastes, control blood pH, regulate fluid and electrolyte balance, as well as produce several hormones; loss of kidney function results in accumulation of toxic wastes, electrolyte imbalances, and a number of other health problems.
The disease develops slowly over time, progressing from renal insufficiency to end-stage renal failure. Often, initial loss of renal tissue does not produce any symptoms. Symptoms typically appear when a significant portion of kidney function is already lost. The ability to concentrate urine is usually the first to be impaired, resulting in frequent trips to the bathroom, especially at night. Other early signs include fatigue, loss of appetite, and decreased mental ability.
Chronic high blood glucose levels, together with high blood pressure caused by diabetes, bring damage to tiny blood vessels in the kidneys, affecting their functions. Cellular degeneration in the functional units of the kidneys, the nephrons, in particular the podocytes of renal glomeruli, further contributes to the impairment of renal functions.
Diabetes, especially when poorly managed, is the biggest risk factor for chronic kidney disease. Other risk factors are the same as those for high blood pressure and include smoking, having high cholesterol levels, and being overweight.
Because initial loss of renal tissue does not produce any symptoms, it is important for diabetic patients to test annually for kidney functions. The tests typically include blood and urine analysis.
Prevention and management strategies consist of controlling blood sugar levels, blood pressure, and cholesterol levels; all of which can be achieved with a combination of lifestyle changes and medications.
Lifestyle measures typically include a healthy diet with low salt intake, increased physical activity, weight management, and smoking cessation.
Among all blood pressure lowering medications, ACE inhibitors and angiotensin receptor blockers, which block the renin–angiotensin–aldosterone system, work best to protect kidney functions.
End-stage kidney disease requires dialysis or kidney transplantation.